Trauma- and Stressor-Related

Disorders

SAMIA MAZHAR
 Introduction

• Trauma- and stressor-related disorders is

new category in DSM-5
• Includes:
– Acute Stress Disorder
– Adjustment Disorder
– Posttraumatic Stress Disorder (PTSD)
– Reactive Attachment Disorder
– Disinhibited Social Engagement Disorder

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 – Child Abuse and Neglect
– They also receive harsh physical punishment
by a parent or other caregiver that puts them
at risk of injury

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 Child Abuse and Neglect (cont’d.)

• Four primary acts of child maltreatment

– Physical abuse, neglect, sexual abuse, and
emotional abuse
• Non-accidental trauma
– Wide-ranging effects of maltreatment on the
child’s physical and emotional development
• Victimization
– Abuse or mistreatment of someone whose
ability to protect himself or herself is limited

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Trauma, Stress, and Maltreatment: Defining
Features
• DSM-5 considers some forms of child
stress and maltreatment under the
category “Other conditions that may be a
focus of clinical attention.”
• A child who was abused and also suffering
from a clinical disorder (e.g., depression)
– The maltreatment would be noted as part of
the diagnosis in order to ensure proper
treatment

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 Trauma and Stress

• Trauma and stressful experiences in

childhood or adolescence may involve:
– Actual or threatened death or injury, or a
threat to one’s physical integrity.
• Children exposed to chronic or severe
stressors, e.g., major accidents, natural
disasters, kidnapping, brutal physical
assaults, war and violence, or sexual
abuse, have an elevated risk of PTSD

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 Three Forms of Child Neglect

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 Acute Stress Disorder
A. Exposure to actual or threatened death, serious injury, or sexual violation in one (or more) of the
following ways:
1. Directly experiencing the traumatic event(s).
2. Witnessing, in person, the event(s) as it occurred to others.
3. Learning that the event(s) occurred to a close family member or close friend. Note: In cases of
actual or threatened death of a family member or friend, the event(s) must have been violent or
accidental.
4. Experiencing repeated or extreme exposure to aversive details of the traumatic event(s) (e.g.,
first responders collecting human remains, police officers repeatedly exposed to details of child
abuse).
Note: This does not apply to exposure through electronic media, television, movies, or pictures,
unless this exposure is work related.
B. Presence of nine (or more) of the following symptoms from any of the five categories of intrusion,
negative mood, dissociation, avoidance, and arousal, beginning or worsening after the
traumatic event(s) occurred:
Intrusion Symptoms
1. Recurrent, involuntary, and intrusive distressing memories of the traumatic event(s). Note: In
children, repetitive play may occur in which themes or aspects of the traumatic event(s) are
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expressed.
2. Recurrent distressing dreams in which the content and/or affect of the dream are
related to the event(s). Note: In children, there may be frightening dreams without
recognizable content.
3. Dissociative reactions (e.g., flashbacks) in which the individual feels or acts as if the
traumatic event(s) were recurring. (Such reactions may occur on a continuum, with the
most extreme expression being a complete loss of awareness of present
surroundings.) Note: In children, trauma-specific reenactment may occur in play.
4. Intense or prolonged psychological distress or marked physiological reactions in
response to internal or external cues that symbolize or resemble an aspect of the
traumatic event(s).
Negative Mood
5. Persistent inability to experience positive emotions (e.g., inability to experience
happiness, satisfaction, or loving feelings).
Dissociative Symptoms
6. An altered sense of the reality of one’s surroundings or oneself (e.g., seeing oneself
from another’s perspective, being in a daze, time slowing).
7. Inability to remember an important aspect of the traumatic event(s) (typically due to
dissociative amnesia and not to other factors such as head injury, alcohol, or drugs).

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Avoidance Symptoms.
8. Efforts to avoid distressing memories, thoughts, or feelings about or closely associated
with the traumatic event(s).
9. Efforts to avoid external reminders (people, places, conversations, activities, objects,
situations) that arouse distressing memories, thoughts, or feelings about or closely
associated with the traumatic event(s).
Arousal Symptoms
10. Sleep disturbance (e.g., difficulty falling or staying asleep, restless sleep).
11. Irritable behavior and angry outbursts (with little or no provocation), typically
expressed as verbal or physical aggression toward people or objects.
12. Hypervigilance.
13. Problems with concentration.
14. Exaggerated startle response.
C. Duration of the disturbance (symptoms in Criterion B) is 3 days to 1 month after trauma
exposure. Note: Symptoms typically begin immediately after the trauma, but persistence
for at least 3 days and up to a month is needed to meet disorder criteria.
D. The disturbance causes clinically significant distress or impairment in social,
occupational, or other important areas of functioning.
E. The disturbance is not attributable to the physiological effects of a substance (e.g., medication or
alcohol) or another medical condition (e.g., mild traumatic brain injury) and is not better explained by
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brief Learning
psychotic 2016
disorder.
 Adjustment Disorder

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 Trauma- and Stress-Related Disorders:
1. Reactive Attachment Disorder

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 2. Disinhibited Social Engagement
Disorder

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 3. Post-Traumatic Stress Disorder

• Acute stress disorder is characterized by:

– The development during or within 1 month after
exposure to an extreme traumatic stressor of at
least nine symptoms associated with intrusion,
negative mood, dissociation, avoidance, and
arousal
• Children who react to more common (and less
severe) forms of stress in an unusual or
disproportionate manner may qualify for a
diagnosis of adjustment disorder
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 Post-Traumatic Stress Disorder (cont’d.)

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 Post-Traumatic Stress Disorder (cont’d.)

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 Post-Traumatic Stress Disorder (cont’d.)

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 Post-Traumatic Stress Disorder For
Children Six and Younger

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 Post-Traumatic Stress Disorder For
Children Six and Younger (cont’d.)

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 Post-Traumatic Stress Disorder For
Children Six and Younger (cont’d.)

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 Associated Problems and Adult
Outcomes
• PTSD can become a chronic psychiatric
disorder for some children and youths
– May persist for decades and in some cases
for a lifetime (Nader & Fletcher, 2014).
– Children and youths with chronic PTSD may
display a developmental course marked by
remissions and relapses
– In a less common delayed variant, children
exposed to a traumatic event may not exhibit
symptoms until months or years later
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 Mood and Affect Disturbances
• Symptoms of depression, emotional distress, and
suicidal ideation are common among children with
histories of physical, emotional, and sexual abuse
• Teens with histories of maltreatment have a much
greater risk of substance abuse
• Childhood sexual abuse also can lead to eating
disorders, such as anorexia nervosa and bulimia
nervosa
• In reaction to emotional and physical pain from abusive
experiences, children or adults voluntarily or involuntarily
may induce an altered state of consciousness known as
dissociation
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 Sexual Adjustment

• Sexual abuse, in particular, can lead to

traumatic sexualization, in which a child’s
sexual knowledge and behavior are
shaped in developmentally inappropriate
ways

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 Causes: Poor Emotion Regulation

• Maltreated infants/toddlers have difficulty

establishing reciprocal, consistent
interaction with caregivers
– Exhibit insecure-disorganized attachment
– Have difficulty understanding, labeling, and
regulating internal emotional states
– Learn to inhibit emotional expression and
regulation, remaining more fearful and on
alert

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Causes: Emerging View of Self and Others

• Maltreated children’s emerging views of

self and their surroundings are not
fostered by healthy parental guidance and
control
– Emotional and behavioral problems are likely
to appear
– Negative representational models of self and
others develop based on a sense of inner
“badness,” self-blame, shame, or rage

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 Causes: Neurobiological Development

• Children and adults with a history of child

abuse show long-term alterations in the
hypothalamic–pituitary–adrenal (HPA) axis
and norepinephrine systems
– These alterations have a significant affect on
responsiveness to stress
• Affected brain areas:
– Include the hippocampus, prefrontal cortex,
and amygdala

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 Neurobiological Development (cont'd.)

• Acute and chronic forms of stress

associated with maltreatment may cause
changes in brain development and
structure from an early age
– The neuroendocrine system becomes highly
sensitive to stress
• Causing neurobiological changes that may account
for later psychiatric problems

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 Prevention and Treatment

• Obstacles to intervention and prevention

services for maltreating families
– Those most in need are least likely to seek
help
– They are brought to the attention of
professionals after norms or laws have been
violated
– Parents do not want to admit to problems for
fear of losing their children or being charged
with a crime
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 Exposure-Based Therapy

• Following acute stress or trauma, such as

motor vehicle accidents, shootings,
bombings, and hurricanes
– Early exposure intervention has reduced
acute stress symptoms
• Many of these interventions are brief,
ranging from 1 to 10 sessions
– Are often delivered in groups to reach as
many children as possible.
• Psychological First Aid (PFA)
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 Exposure-Based Therapy (cont’d.)

• In-depth psychological interventions are

for children who are severely affected by a
traumatic event
– The child typically begins by describing a
particular traumatic incident and their feelings
and thoughts about it
• Types
– Grief and Trauma Intervention for Children
– Trauma-focused cognitive-behavioral therapy
(TF-CBT)
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 Preventing Abuse and Its Long-Term
Outcomes

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 Special Needs of Maltreated Children -
Physical Abuse and Neglect
• Interventions for physical abuse usually
involve ways to change how parents
teach, discipline, and attend to their
children
• Treatment for child neglect focuses on
parenting skills and expectations, coupled
with teaching parents how to improve their
skills in organizing important family needs

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 Special Needs of Maltreated Children:
Sexual Abuse
• Treatment programs for children who have
been sexually abused provide several
crucial elements to restore the child’s
sense of trust, safety, and guiltlessness
• TF-CBT has been adapted for child sexual
abuse victims and others with complex
trauma symptoms

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